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| electrons admitted from a cathode strike an anode to [roduce the xray |
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| the greater the density, the greater the absorption or scatter of x-rays, need to have contrast in densities to see different structures |
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| brighter, loose borders between higher densities |
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| darker, loose borders between lower densities |
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| the further away from the plate, the larger it will look, want objects right next to plate |
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| where to put the plate for xrays |
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| front part of the chest, close to the heart for accurate heart size (we want a PA film) |
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| lateral films are named how |
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| on the side that is closest to the film |
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| pt tilts backwards, shows behind clavicles, used for upper lung masses such as tuberculosis diagnosis |
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| degree of rotation of the body between frontal and lateral, often used w cervical spine to look for bony abnormalities |
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| lateral decubitus named based on |
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| for x-rays need a minimum of |
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| 2 views at 90 deg angles to each other |
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| 10 steps of reading x-rays |
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| Identification/Quality, soft tissue, bones, diaphragm, mediastinum, heart and great vessels, pleura, lung fields, funny looking things, lateral film, check old films |
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| do you have the right patient? correct date? check for R/L marker, check quality of film/overexposure/under--if you don't see the thoracic vertebrae the film is underexposed, if don't see vessels in lung film is overexposed, a good film will expose the 6th rib anteriorly and the 10th rib posteriorly at the mid of the right hemidiaphragm for good lung expansion, want to note the position and distance from medial end of each clavicle to spinous processes and see that they are at the same level |
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| look outside the ribcage and at the upper extremities before looking at heart and lungs, look at soft tissue for masses, swelling, air, foreign bodies, look for breast or pectoral muscle shadows, and then nipple shadows (can be confused with pulmonary lesions) |
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| should be able to see proximal humerus, clavicles, scapula, ribs, sternum and vetebral bodies, look for bone mets from cancer or signs of trauma |
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| right should be higher than left bc of liver, should be no more than 1 rib interspace, look for free air, look at costophrenic angle, |
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| center portion of chest, look for normal narrowing of the air column at the vocal chords, should see carina of trachea around T4, T5, look for deviation of trachea to right at level of transverse aortic notch, the aortic knob is in the way on the rt side so sometimes things will shift, the right mainstem bronchus usually has a more vertical orientation than the left, , look at the lymph nodes for enlargement or calcification- lymphoma, sarcoidosis, pneumoconiosis, lung disease (severe mediastinal lymphadenopathy), |
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| cardiac size and contour, heartspan should be less than half of the transverse diameter of the rib cage, if greater- cardiac englargement or cardiomegaly, must be PA film, look at rt heart border (mainly rt atrium) (rt ventricle is behind the heart), 4 major little bumps on left heart border (aortic knob, pulmonary artery, left atrial appendage, left ventricle-making up most of lt border), lung hila should be higher on left than right, should not be greater than 1 ribspace, |
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| look at costophrenic angles- should be nice and sharp with no fluid, need at least 300ccs of fluid before you would be blunting of this angle, look at top of lungs for if there's asymmetric thickening of the walls could be a pleural malignancy such as mesothelioma |
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| compare one side to the other, make sure lung markings taper all the way out to the periphery until they end if they don't it could be a sign of a collapsed lung, pneumothorax. the pulmonary vessels should taper as they branch out and become more peripheral, you may see some lung densities or airspace disease, it's a nodule in the lung if it's less than 3cm in size, it's a mass if it's greater than 3cm in size, look at the fissures-separations between the lobes of the lungs- they stand out bc theres some fluid in them |
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| in PA view have minor fissure separating right, lower and middle lobes, on lateral films you will see 2 fissures, a major and a minor. the major will separate the upper, left upper and lower lobes and the minor fissure runs from the anterior chest well to intersect with the major fissure, |
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| look for ET tubes, chest tubes, pacemakers, catheters, anything that's not supposed to be there |
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| use to confirm and localize lesions, taken on the left side as this does not enlarge the cardiac size, go through all the same steps to examine, as you follow the airway down you will see 2 small lucencies- upper lobe bronchi, retrosternally look for masses, check for the inferior vena cava and maybe some consolidation in the lungs and look at spine density as you go down, may see osteoporosis or osteopenia |
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| blue circle is mass, red circle is met |
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| look below diaphrgm for free air |
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| hilar and mediastinal nodes |
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| costophrenic angles, blunted on left and normal on right |
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| calcified nodule and mass |
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| top- horizontal fissure, bottom- oblique fissure |
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| Atalectasis, collapse of area of lung, affected area is white |
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| atelectasis is what and 3 major causes |
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| collapsed area of the lung due to air being reabsorbed, small area or alveoli. 1. obstruction due to mass or foreign body 2. compression due to space-occupying lesions 3. traction due to scarring from TB or fibrosis, common finding post-op when not taking deep breaths to expand lungs (why we use incentive spirometry post-op to get them to expand their lungs) |
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| hyperlucency or lack of lung markings at the periphery of the lungs, open air space shows up black (collapsed lung), mediastinum or trachea can shift to a side |
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| could be asthma, bronchitis, or emphysema, flattened diaphragm, hyperinflation or expanded lungs, could see big barrel chest on lateral |
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| blunting of the costophrenic angles due to fluid, at least 300ccs, may see fluid in right middle lobe fissure, can lay person on side to observe if it is stuck in that spot (loculated), |
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| redistribution of blood flow to the upper lobes, interstitial edema and blurring edges of the blood vessels, butterfly lines, kerley b lines, increased pulmonary vasculature, increased fluid in the lungs, enlarged heart (more than half), |
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| fluid filled fissures at the periphery of the lung, classic in CHF |
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| pulmonary embolism findings |
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| normal x-ray or westermark sign (blood vessels all the sudden stop- tells you there is a clot) or hampton's hump (hump-shaped lesion w it's base attached to pleural surface and convex apex towards the hilum. often mistaken for an infiltrate due to pneumonia). |
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| where the pneumonia is is based on what structures you can't see. if you can't see the left border of the heart, the linguila of the heart or lung is infected. if you can't see the right border of the heart, the right middle lobe could have the infiltrate, the upper left heart border- anterior segment of left upper lobe, if you can't see ascending aorta- anterior segment of right upper lobe, |
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| based on what lobe you're looking at, how they overlap and what it would look like if there's an infiltrate |
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| primary TB shows airspace disease in lower lobes, can show pleural effusion and Hiler lymphadenopathy, usually a latent TB CXR is normal, in secondary may see upper lobe cavity or scar tissue, cavitary lesion can be seen in TB |
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